Or. Admin. Code § 333-004-4130

Current through Register Vol. 63, No. 11, November 1, 2024

Section 333-004-4130 - Requests for Reconsideration

(1) An authorized agency or authorized provider may request reconsideration of a RH Program decision that directly adversely affects the agency or provider such as:

(a) A denial or limitation of payment allowed for services or items provided.

(b) A RH Program overpayment determination made under OAR 333-004-4110 (Recovery of RH Access Fund Overpayments Resulting from Review or Audit).

(c) A sanction.

(2) An authorized agency or authorized provider may request reconsideration by filing a written request with the RH Program within 30 calendar days of the date the RH Program's decision was mailed. A request for reconsideration must:

(a) Provide a clear written expression from an agency or provider identifying the RH decision that is at issue.

(b) Explain the specific reason or reasons the authorized agency or authorized provider disagrees with that decision along with supporting documentation if applicable.

(c) Be received by the RH Program within 30 calendar days of the date the RH Program's decision was mailed in order to be considered timely.

(3) If an authorized agency's or authorized provider's request for appeal is not timely, the authorized agency or authorized provider may accept the late request only if the cause for failure to timely request the hearing was beyond the reasonable control of the authorized agency or authorized provider. The RH Program may require the request to be supported by a written statement that explains why the request for review is late.

(4) A request for reconsideration will be reviewed by the Center for Prevention and Health Promotion (Center) administrator or designee. The administrator or designee may issue a decision on reconsideration based on the information submitted by the authorized agency or authorized provider or may request a meeting between the authorized agency or authorized provider and RH Program staff. If a meeting is requested the Center administrator or designee shall notify the authorized agency or authorized provider of the date, time, and place the meeting is scheduled. The meeting may be in person, by phone, or by video conference.

(a) The review meeting shall be conducted in the following manner:

(A) It shall be conducted by the Center administrator or designee;

(B) No minutes or transcript of the review will be made by the Authority;

(C) The authorized agency or authorized provider requesting the review need not be represented by counsel and shall be given ample opportunity to present relevant information; and

(D) RH Program staff may attend and participate in the review meeting but only the Center administrator or designee may ask the RH Program staff questions;

(b) An authorized agency's or authorized provider's failure to appear without good cause constitutes acceptance of the RH Program's determination;

(c) The Center administrator may combine similar administrative review proceedings, including the meeting, if the Center administrator determines that joint proceedings may facilitate the review; and

(d) The Center administrator or designee may request the authorized agency or authorized provider requesting reconsideration to submit, in writing, new information that has been presented orally. In such an instance, a specific date for receiving such information shall be established.

(5) The decision on the request for reconsideration shall be sent to the authorized agency or authorized provider in writing, explaining the basis for the decision.

(6) The burden of presenting evidence to support a request for reconsideration is on the authorized agency or authorized provider.

Or. Admin. Code § 333-004-4130

PH 47-2023, adopt filed 09/28/2023, effective 10/1/2023

Statutory/Other Authority: ORS 413.042 & OL 2022, Ch. 435 (HB 4034, Section 10)

Statutes/Other Implemented: ORS 413.032 & OL 2022, Ch. 435 (HB 4034, Section 10)